Physician specialty and patient's satisfaction with communication as determinants of trust

Background: Research has consistently portrayed patient centered communication as a main determinant of patient trust in physicians, including among cancer patients. However, little is known about the relationship between physician specialty and trust, given expected differences in patient-provider communication between physician specialties. Understanding the determinants of physician trust among cancer patients provides a novel approach to improving their health outcomes. Objective: To examine whether engagement with surgeons (vs. general practitioners and oncologists) affects cancer patient's level of trust. And to further explores the role of satisfaction with patient centered communication behaviors by proposing a mediation mechanism: engagement with surgeon a satisfaction a trust. Methods: Participants: 692 randomly sampled Pennsylvania breast, prostate and colorectal cancer patients diagnosed in 2005 who completed a mail survey three years after diagnosis. Analyses: OLS regression and Sobel's mediation test. Measures: communication satisfaction and trust scales were taken from the Primary Care Assessment Survey, engagement referred to seeing/taking to a surgeon (vs. general practitioner or oncologist) most in the past year (dichotomous-yes/no). Results: Engaging with surgeons was associated with higher satisfaction with communication (B=0.192,p<0.01) and trust (B=0.367,p<0.001). Furthermore, the proposed mediation mechanism was confirmed (Coefficient=0.08,p< 0.05). Conclusions: Contrary to popular perceptions, cancer patients report higher trust in their provider if they are cared for by a surgeon than a primary care provider or oncologist, at least in part because they are more satisfied with their communication with surgeons. More research is needed to understand the reasons for these differences and their downstream impact on health outcomes.